Cost-effectiveness analysis of Intravascular Temperature Management after cardiac arrest in England

BackgroundAlthough there is recognized that Targeted Temperature Management (TTM) can improve neurological outcomes and survival in patients resuscitated from out of hospital cardiac arrest, the cost-effectiveness of multiple methods of TTM is still uncertain.ObjectiveThis study aimed to evaluate the cost-effectiveness of Intravascular Temperature Management (IVTM) through Thermogard XP in targeted temperature management compared to surface cooling method after cardiac arrest in England.MethodsWe developed a multi-state Markov model that compared intravascular temperature management through Thermogard XP and the surface cooling method through two different devices including Blanketrol III and Arctic Sun 5000, over a short-term and lifetime horizon. Model input parameters were obtained from the literature and local databases. We assumed hypothetical cohort of 1,000 patients who need TTM after cardiac arrest per year in England. The outcomes were costs (in 2019 £) and quality-adjusted life-years (QALYs), discounted at 3.5% annually. Deterministic and probabilistic analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results.ResultsIn a simulated cohort of 1,000 patients who need TTM, the Thermogard XP resulted in direct cost savings of £2,339 and £2,925 (per patient) when compared with Blanketrol III and Arctic Sun 5000 respectively, and a gain of 0.98 QALYs over the patient lifetime. Total cost saving considering cohort of 1,000 patients is £2,339,479 and £ 2,925,109 when using IVTM through Thermogard XP compared with Blanketrol III and Arctic Sun 5000 respectively in life-time horizon. Results were robust against alternative assumptions, changes in values of input parameters, and alternative time horizons.ConclusionImplementation of intravascular temperature management using Thermogard XP can lead to cost-savings and improvement in patients’ quality of life versus surface cooling methods.